Risk assessment to guide prostate cancer screening decisions: a cost‐effectiveness analysis

Abstract

CORRECTIONError in calculating costs of screening: In "Risk assessment to guide prostate cancer screening decisions: a cost-effectiveness analysis" in the 3 June 2013 issue of the Journal (Med J Aust 2013; 198: 546-550), there was an error in the way screening costs were calculated. These corrections do not alter the study conclusions. The corrected figures are in bold as follows.Results section of the abstract (page 546): "The base-case incremental cost effectiveness ratio of PSA screening was $168 611 per QALY for men with average risk, $73 452 per QALY for men with two times the average risk,

Benefits, harms and cost-effectiveness of cancer screening in Australia: an overview of modelling estimates

“…48 An Australian study used a single-cohort Markov model to evaluate the cost-effectiveness of 4-yearly PSA testing versus no testing for men at average risk, high risk (two times the average risk) and very high risk (five times the average risk) for prostate cancer. 49 This evaluation found that annual PSA testing may be cost-effective for very high-risk men (CER: $22 938/QALYS, equivalent to CER $28 140/QALYS in 2018 value) but not for averagerisk or high-risk men.…”

What does it cost Medicare to diagnose and treat men with localized prostate cancer in the first year?

“…This cost is lower than the estimated cost of $20 077 for the treatment of prostate cancer in the Australian cost‐effectiveness study by Martin et al . (2013) . It is possible that the control group used in our analysis had medical conditions that required continuing drug treatment; this decreased the PBS costs attributable to prostate cancer as estimated in our study.…”

“…Thus, international health authorities have encouraged men with low‐risk prostate cancer to be managed with active surveillance . The implications of these changing patterns of care may result in shifting the healthcare costs from the first year of diagnosis to later years, with more patients put under active surveillance before any treatment becomes necessary . Alternatively, healthcare costs will be reduced in those men on active surveillance who never require active treatment.…”

“…The latest government report on health system expenditure for cancer estimated the lifetime cost of prostate cancer was $14,474 (2008–2009) per incident case and $19,427 for men aged over 65 years . One cost‐effectiveness study estimated that the cost of treatment for prostate cancer in Australia was $20,077 (2012 AUD) . Although no Australian study was identified that described patient‐level healthcare resources and costs, an assessment report to the Medical Services Advisory Committee has provided details on unit costs to Medicare and other agencies for various treatments (http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1089.1-public).…”

Serum Sarcosine and PSA Levels in Patients With Prostate Cancer in Sokoto, Nigeria.

“…Malignant prostate cells progress through a series of genetic and epigenetic changes leading to aberrant proliferation, angiogenesis, evasion of apoptosis and metastasis to secondry sites 3 Between 2001 to 2002, the proportion of black patients presenting with high, intermediate and low risk disease in the US, changed to 14.8%, 37.5% and 47.7% respectively 4 . As Prostate cancer progression is reported to involve activation of many signaling pathways , intense research efforts to identify serum and tissue biomarkers will expand the opportunities to understand these functional activation of cancer related pathways and consequently lead to correct diagnosis and therapeutic interventions 5 .Just like fingerprint is unique to each person, cancer cells lines exhibit signature proteins pathways, differentiating them from surrounding tissues and other tumors. When these molecular signatures are determined, an individual cancer can be definitely identified, assigned expected pattern of disease progression and therapeutically targeted 6 , hence the rationale for our study.…”